Emergency Medicine Journal最新文献

{"title":"Experience and needs of emergency nurses in palliative care: a qualitative meta-synthesis.","authors":"Na Liu, Lina Chen, Xinrui Mao, Shuqin Xia, Qi Wang, Dandan Hu, Runv Zhou, Weiying Zhang","doi":"10.1136/emermed-2025-215369","DOIUrl":"10.1136/emermed-2025-215369","url":null,"abstract":"<p><strong>Objective: </strong>This study seeks to explore the experiences of emergency nurses in providing care to patients nearing the end of life and to identify the needs of emergency nurses in the palliative care (PC) process.</p><p><strong>Methods: </strong>A qualitative meta-synthesis approach (following Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines) was implemented to systematically review relevant qualitative studies. A comprehensive search was conducted across multiple databases, encompassing PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature; (CINAHL), PsycINFO, Web of Science, CNKI (China National Knowledge Infrastructure), Wanfang database and Scopus. The search duration was from database inception to March 2025.</p><p><strong>Results: </strong>In total, 22 studies complied with the inclusion criteria and were included in the meta-synthesis. Three main themes were identified: (i) needs for emergency palliative care (EPC) and current practice in emergency departments (EDs); (ii) emotional, ethical and communication experiences of nurses in providing PC in EDs; (iii) nurses' perceived needs for training, support and system coordination. Across studies, EPC in the ED was described as occurring alongside acute life-saving care. Nurses' experiences and attitudes towards EPC varied significantly, ranging from positive engagement to perceived incompatibility with their roles in emergency care.</p><p><strong>Conclusion: </strong>This meta-synthesis highlights the complexity of providing PC in EDs and the urgency of implementing systematic interventions. To enhance the effectiveness and quality of EPC, it is necessary to provide systematic support and targeted strategies, thereby helping emergency nurses better meet the needs of patients at the end of life.</p><p><strong>Prospero registration number: </strong>CRD420251008755.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"577-583"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal update monthly top five.","authors":"Sruthi Sarma, Abby Grant, Brian Doyle, Viet Tran, Thomas Alexander Gerrard Shanahan","doi":"10.1136/emermed-2026-216285","DOIUrl":"https://doi.org/10.1136/emermed-2026-216285","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"43 9","pages":"593-594"},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric electric-scooter injuries: an emerging public health crisis?","authors":"Lisa Sabir, Sabrina Waheed, Caroline Rushmer, Harry Helliwell, Alex Scott, Rachel Tricks, Charlotte Durand","doi":"10.1136/emermed-2026-215992","DOIUrl":"https://doi.org/10.1136/emermed-2026-215992","url":null,"abstract":"<p><strong>Background: </strong>Electric-scooters (e-scooters) are popular worldwide although there are concerns about their regulation and safety. Since 2019, 59 deaths have been reported in the UK involving e-scooters; 10 under 18 years old. In the UK riding privately owned e-scooters is illegal unless on private land. We reviewed e-scooter injuries in patients presenting to Emergency Departments of three UK Paediatric Major Trauma Centres.</p><p><strong>Methods: </strong>This was a retrospective observational study of e-scooter-related injuries in patients under 16 years-old from January 2019 to December 2024 at Alder Hey Children's Hospital (AH), Sheffield Children's Hospital (SCH) and Royal Manchester Children's Hospital (RMCH). Patients were identified via electronic triage records and cross-referenced with trauma lists. At RMCH, a change in software limited data collection to 2023-2024. Descriptive statistics were used with 95% CIs for key proportions.</p><p><strong>Results: </strong>477 patients presented with increasing incidence over the 6 year period. Median age was 12 years (IQR 10-13), with a male predominance (64.4%). Most injuries occurred to the rider (94.8%) and ≥80% were private e-scooters. 2.5% occurred on private land.Most common injuries were limb (40.6% lower, 36.2% upper), head (24.1%), and facial (18.4%) injuries. 10.4% of head injuries had an Abbreviated Injury Scale (AIS) score of 3 or 4, indicating major trauma necessitating imaging, hospital admission, and surgical intervention. Of the most seriously injured (AIS 3 or 4), 48% were from a collision with a motor vehicle or stationary object. Only 1.8% were wearing a helmet; 13.4% were admitted and 6.9% required surgery. Most injured children (74%) lived in the most deprived areas (Index of Multiple Deprivation (IMD) 1/2).</p><p><strong>Conclusion: </strong>E-scooter related injuries are rising. Limb, head and facial injuries were most common, with head injuries being most severe, this has serious life-changing implications for families and significant impact on healthcare resources. There is a need for greater public awareness, clear public health messaging and review of government legislation to prevent further injuries and deaths.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulance clinicians' perceptions and experiences of managing risk during decision-making in care homes.","authors":"Fawn Harrad-Hyde, Kay Harrad-Hyde, Tanatswa Muzembe, Nicola Mackintosh","doi":"10.1136/emermed-2025-215827","DOIUrl":"https://doi.org/10.1136/emermed-2025-215827","url":null,"abstract":"<p><strong>Background: </strong>Ambulance clinicians play a key role in decision-making when care home residents experience deteriorations in their health. An emerging evidence base suggests ambulance clinicians weigh up risk during decision-making but provides limited insights into how they do so. Therefore, this study aimed to explore ambulance clinicians' experiences of balancing and managing risk(s) when attending calls to care homes.</p><p><strong>Methods: </strong>Online semistructured interviews were conducted with 22 ambulance clinicians working in a variety of roles across seven NHS Ambulance Trusts in the UK. Data were analysed thematically using a constructivist approach.</p><p><strong>Results: </strong>Three themes describe the ways ambulance clinicians manage risk when attending calls to care homes. The first theme outlines five forms of risk that ambulance clinicians weigh up, including risks to residents, themselves as decision-makers, their interpersonal relationships, their employing organisation and wider healthcare services. The second theme outlines the actions ambulance clinicians undertake to manage risk. Involving others in decision-making is a key action through which ambulance clinicians manage risk but doing so introduces the need to negotiate with others. Therefore, the third theme explores the multiple factors that shape ambulance clinicians' experiences of weighing up risks and negotiating with others. These factors align with the forms of risks ambulance clinicians manage during decision-making and include resident, decision-maker, interpersonal, organisational and systemic factors.</p><p><strong>Conclusions: </strong>This study highlights the complexity involved in ambulance clinicians' decision-making in care homes. The findings identify a number of important implications for research, policy and practice. This includes the need for further work to develop cross-sector practices and policies of accountability, to improve the number and quality of advance care plans and to ensure the current and future ambulance workforce are equipped to undertake the complex negotiation work involved in managing risks during decision-making in care homes.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In children requiring emergency vascular access, are intraosseous lines associated with significant long-term complications?","authors":"Emma Lydia Jane Carley, Gregory P Yates","doi":"10.1136/emermed-2026-216214","DOIUrl":"https://doi.org/10.1136/emermed-2026-216214","url":null,"abstract":"<p><p>Intraosseous (IO) access is a technique increasingly used within trauma and emergency settings where immediate vascular access is required. It provides an effective alternative to intravenous access, particularly in paediatric patients where intravenous access is difficult, or where previous attempts have been unsuccessful. However, concerns remain regarding potential complications associated with IO use, including potential long-term adverse outcomes.A short cut review of the literature was carried out to determine long-term outcomes of IO access in paediatric patients requiring emergency vascular access. A total of 282 unique papers were found, of which 11 observational studies (three prospective, eight retrospective) included data on patients relevant to the clinical question; these are discussed in the paper. Across these studies, severe long-term complications following paediatric IO access were rare. Only one study reported a single case of osteomyelitis following IO access. No evidence of growth disturbance, venous thrombosis or fat embolism was identified, while isolated cases of compartment syndrome, fracture and extravasation were reported at low frequency. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated.The clinical bottom line is that severe complications are rarely reported with paediatric IO lines. Emergency clinicians should not be deterred from inserting or retaining IO lines when definitive intravenous access has yet to be established.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic equity measured by Indices of Multiple Deprivation for HEMS-attended major trauma in South East England: heterogenous effects in severe traumatic brain injury.","authors":"Joanne Griggs, Jenny Harris, Jack Barrett, Leigh Curtis, Richard de Coverly, Scott Clarke, Duncan Bootland, Emma Ream, Richard Lyon","doi":"10.1136/emermed-2025-215619","DOIUrl":"10.1136/emermed-2025-215619","url":null,"abstract":"<p><strong>Background: </strong>Healthcare inequalities persist across socioeconomic gradients with deprived populations experiencing higher trauma mortality. This study aimed to determine whether 30-day mortality differs across socioeconomic deprivation quintiles in Helicopter Emergency Medical Service (HEMS) attended major trauma and to assess equity of intervention delivery and operational response.</p><p><strong>Methods: </strong>Retrospective service evaluation cohort study of consecutive HEMS-attended major trauma patients (Injury Severity Score (ISS)>15) by Air Ambulance Charity Kent Surrey and Sussex (July 2013-February 2022). Indices of Multiple Deprivation quintiles derived from preassigned Lower Layer Super Output Area (LSOA) at incident location rather than patient residential address were examined alongside mortality outcomes. The primary outcome was 30-day mortality across socioeconomic quintiles (Q), with prespecified subgroups including traumatic haemorrhage and traumatic brain injury (TBI). Geospatial analysis and multivariable logistic regression were performed.</p><p><strong>Results: </strong>Among 1752 major trauma patients (median ISS 27, IQR 21-36) geospatial analysis identified missions in 1190 LSOA codes (10.5% of region), with clustering in areas of moderate deprivation. 30-day mortality showed no socioeconomic gradient: 17% (95% CI 12% to 25%) in Q1 vs 21% (95% CI 17% to 25%) in Q5, p=0.861. Multivariable logistic regression confirmed no independent association between deprivation and mortality (adjusted OR per quintile increase 1.01, 95% CI 0.92 to 1.11, p=0.800). Secondary outcomes demonstrated equitable service provision with prehospital emergency anaesthesia 37-43% (p=0.667), blood transfusion 8-13% (p=0.321) and night operations 28-41% (p=0.124). Exploratory subgroup analysis identified a significant Glasgow Coma Scale×deprivation interaction in TBI (p=0.003), with possible age-dependent variations warranting further investigation.</p><p><strong>Conclusions: </strong>Equitable 30-day mortality outcomes were achieved across socioeconomic quintiles within the operational region examined. A regional HEMS may mitigate health inequalities in major trauma, though complete equity requires addressing broader social determinants of health.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148600465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why AI struggles with rare catastrophic disease: lessons from the AORTA-AI study of acute aortic syndrome.","authors":"Jim Zhong, Peter A Bath, Matthew J Reed, Sarah Wilson, Ganesh Vigneswaran","doi":"10.1136/emermed-2026-216369","DOIUrl":"https://doi.org/10.1136/emermed-2026-216369","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-sectional associations between neurodiversity and violence-related attendances in Welsh Emergency Departments and the role of Hospital-based Violence Intervention Programmes.","authors":"Amrita Bandyopadhyay, Megan Hamilton, Sinead Brophy, Adele Battaglia, Anna Giedroyc, Catherine Bright, Steven J Walden, Simon C Moore","doi":"10.1136/emermed-2025-215624","DOIUrl":"https://doi.org/10.1136/emermed-2025-215624","url":null,"abstract":"<p><strong>Background: </strong>Neurodiversity, including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and learning difficulties, can increase vulnerability to violence. However, the epidemiology of violence-related Emergency Department (ED) attendance among neurodiverse patients remains unknown, as does the extent to which they engage with support services. Hospital-based Violence Intervention Programmes represent a potential strategic response, yet their need for and effectiveness in identifying and supporting neurodiverse patients is unexplored.</p><p><strong>Methods: </strong>A whole-population cross-sectional exploratory study of 3 993 439 Welsh residents (2012-2024) using anonymised routine data. Data linkage identified violence-related ED attendances, neurodiversity diagnoses and comorbid conditions. Multivariable logistic regression models explored associations between neurodiversity and violence-related attendance. There were 9584 patients eligible for Violence Prevention Team (VPT) interventions at two intervention sites and exploratory analyses assessed patients acceptance of support.</p><p><strong>Results: </strong>There were 73 222 ED violence-related attendances. ADHD (n=3511) and learning difficulty (n=1641) were each independently associated with increased violence-related attendance (ADHD, OR 1.67, 95% CI 1.61 to 1.74; mild learning difficulty, OR 1.33, 95% CI 1.25 to 1.40), whereas ASD (n=1148) was associated with a lower likelihood of violence-related attendance (OR 0.71, 95% CI 0.67 to 0.76). Of the eligible patients, VPTs contacted 4007 (41.8%); 2560 engaged with support while 1180 refused. Males and individuals with a history of alcohol misuse, substance misuse, or being a looked-after child were more likely to refuse support. In contrast, diagnoses of ASD, ADHD, and learning difficulties were not associated with support refusal.</p><p><strong>Conclusion: </strong>ADHD and learning difficulty are over-represented among violence-related ED attendees; however, neurodiversity does not predict unwillingness to engage with intervention services. Hospital-based violence prevention programmes are feasible within UK ED and can identify neurodiverse patients. Resource limitations currently restrict coverage. These findings support the need for sustained violence prevention services to optimise identification and support of vulnerable populations.</p><p><strong>Trial registration number: </strong>ISRCTN68945844.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In children presenting to the paediatric emergency department (PED) with acute gastroenteritis, does the use of probiotics lead to a shorter duration of diarrhoeal symptoms?","authors":"Megan Littlewood, Edward Showler","doi":"10.1136/emermed-2026-216212","DOIUrl":"https://doi.org/10.1136/emermed-2026-216212","url":null,"abstract":"<p><p>A short review of the literature was conducted to assess whether probiotics shorten the duration of diarrhoeal symptoms in children presenting with acute gastroenteritis to the paediatric emergency department (PED). A keyword search of Cochrane, EMBASE, MEDLINE and Google Scholar identified five relevant papers. The author, patient group, study type, key results and study weaknesses were tabulated. Our review concludes that probiotics should not be prescribed to PED patients with gastroenteritis, as they do not appear to reduce the duration of diarrhoeal symptoms.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Black-white implicit bias among healthcare workers in UK emergency departments: findings from the multicentred BiasED Study.","authors":"Fleur Cantle, Carole Reid, Sarah Williams, Raeesa Jina, Caitlin Spooner, Chistopher Corbett, Rosa Harrington, Susie Hardwick, Valentino Oriolo, Ruth Tampsett, Rebecca Macfarlane, Jennifer R R Steele","doi":"10.1136/emermed-2025-215003","DOIUrl":"https://doi.org/10.1136/emermed-2025-215003","url":null,"abstract":"<p><strong>Background: </strong>Addressing racial bias in healthcare is crucial for ensuring equitable treatment and outcomes. We aimed to explore implicit (unconscious) racial bias among healthcare professionals in UK emergency departments (EDs).</p><p><strong>Methods: </strong>BiasED was an online survey disseminated to healthcare professionals working at 16 UK EDs. Participants completed the race (black/white) Implicit Association Test (IAT), which explores potential implicit bias by examining response times for positive and negative associations for white and black people. Differences were measured using the <i>D</i> score (range -2 to 2, where 0 indicates neutral bias and positive scores indicate pro-white bias). Explicit attitudes and stereotypes were also explored by participants' self-report.</p><p><strong>Results: </strong>969 healthcare workers participated, including doctors (42%), nurses (43%) and other healthcare professionals (median age 36 years; 66% female; 67% white). Self-report measures indicated little explicit bias, with 87% reporting equal preference for black and white people. Black participants expressed more positive attitudes about black people than white or Asian participants.The IAT indicated a pro-white bias (<i>D</i>=0.32, SD=0.42, p<0.001), considered a small to medium effect. Men (<i>D</i>=0.36) showed more implicit bias than women (D=0.29, p=0.03). White (D=0.34) and Asian (D=0.37) participants showed more bias than black (D=0.09) participants. No significant differences were found between medical professions. Except for black participants, all groups showed a pro-white bias on the IAT.</p><p><strong>Conclusion: </strong>The study identified evidence of implicit racial bias among healthcare workers in UK EDs. These findings highlight the complex nature of racial attitudes in healthcare and emphasise the need for comprehensive bias awareness and mitigation strategies in emergency care settings. Future research should explore the potential impact of these biases on clinical decision-making and patient outcomes.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}